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R2.3 million fraud, 19 GEMS Medical Scheme fraudsters released on bail

Nineteen accused, Nkosazane Nyathi (40)F, Nelile Shabangu(34)F, Brenda Nzima(38)F, Nokuthula Ubisi((40)F, Thabo Ndlozi((38)M, Muideen Moshood(56)M, Lucky Lubisi(37)M, Nomvula Maduna(61)F, Sipho Mkhatywa(50)M, Nomvula Tolla(42)F, Prisca Mokoena(40)F, Sarah Nyambi(53)F, Sharon Williamson (38)F, Veronica Keis(52) F, Vusi Mkhumbane (66)M, victor Mpofu(42) and three entities, Valencia, Nala and Buffelspruit pharmacies appeared before the Nelspruit District Court on Monday, 6 March 2023 after they were arrested by the Hawks Nelspruit based Serious Commercial Crime Investigation for Fraud and Contravention of Medical Scheme Act 131 of 1998.

It is alleged that members of Medical Scheme colluded with Pharmacies to defraud the Medical scheme by means of claiming for services that were not rendered by the pharmacies in exchange for cash or purchasing items that are not covered by the medical scheme.

The allegations relate to the submissions of claims by Valencia, Nala, and Buffelspruit pharmacies to GEMS for services or goods that were not supplied or rendered to the members.

It is further alleged that GEMS`s members received non-medical goods in lieu of the false claims submissions.

GEMS conducted internal investigations to determine the veracity of the allegations of false claim submissions. During investigation, it was discovered that members of the medical scheme colluded with the pharmacy directors, Lucky Velaphi Lubisi, Thabo Ndlozi, Nelile Shabangu and Mukden Mashood to make misrepresentations to GEMS well knowing that, what they were doing was not in line with the prescripts regulating pharmacies as prescribed in the Regulations.

The complaint was reported to the Hawks in 2020, whereby investigation was conducted hence the arrest.

Fourteen accused including three entities were released on R1000-00 bail each, four pharmacists released on R5000-00 bail each and a pensioner was released on warning with conditions that they should not commit any similar offence to the one they are out on bail for.

They should not interfere with witnesses or the investigation. They should also appear in court all the times when they are required.

The case was postponed to 28 March 2023 for further investigation.

More arrest are eminent.

The Provincial Head of the Hawks Major General Nico Gerber applauded the team for the stunning work which includes the National Prosecution Authority. He further warned all government employees to refrain from corruption and fraud. “As the Hawks, we are committed to serving the inhabitants of Mpumalanga and the Country as a whole. “Members need to report corrupt service providers and not get lured into schemes that will land them in trouble and risk their future, said Major General Gerber.”

SAPS Newsroom

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